填表時(shí)務(wù)請(qǐng)參閱《二零一零至一一年度禁毒基金撥款計(jì)劃指引》,

1、二零一零至二零一一年度禁毒基金撥款計(jì)劃Beat Drugs Fund 2010/11Funding Exercise填表時(shí)務(wù)請(qǐng)參閱«二零一零至一一年度禁毒基金撥款計(jì)劃指引»，申請(qǐng)表須於二零一零年三月三十一日下午六時(shí)或之前送交禁毒基金會(huì)(香港金鐘道66號(hào)金鐘道政府合署高座30樓保安局禁毒處轉(zhuǎn)交)This form should be completed with reference to “Guide to Beat Drugs Fund 2010/11 Funding Exercise”. It should be returned to the Beat Drugs Fu

2、nd Association, c/o Narcotics Division, Security Bureau, 30/F, High Block, Queensway Government Offices, 66 Queensway, Hong Kong on or before 6:00 p.m. on 31 March 2010.此欄無(wú)須填寫For Official Use Only檔案編號(hào)Reference No:禁毒基金申請(qǐng)表Beat Drugs FundApplication Form(可用中文或英文填寫。To be completed in Chinese or English)

3、甲部 計(jì)劃資料Part AProject InformationI. 計(jì)劃名稱 Project name中文Chinese: _英文English: _II. 申請(qǐng)人/機(jī)構(gòu) Applicant 中文Chinese: _英文 English: _地址:Address: _電話:傳真:電郵地址:Tel. no. _Fax no. _E-mail address _負(fù)責(zé)人:職銜:Responsible person: _Post title: _可提供更詳盡資料的人士 (如與上述填報(bào)的負(fù)責(zé)人不同)Person to be contacted for further information (if d

4、ifferent from the responsible person)姓名 :職銜 :Name _Post title _地址 :Address _電郵地址 :_E-mail address _電話:傳真:Tel. no. _Fax no. _III. 申請(qǐng)人/機(jī)構(gòu)背景 Background information of applicant(a)(i) 如屬機(jī)構(gòu)，請(qǐng)?jiān)]明 For applicant organisation, please state -是否根據(jù)下列條例註冊(cè)Whether the applicant is registered under - 社團(tuán)條例公司條例Societi

5、es Ordinance Companies Ordinance 其他 (請(qǐng)?jiān)]明)Others (please specify) _(註冊(cè)年份: Year of Registration: _)(ii) 是否稅務(wù)條例第88條所指的慈善機(jī)構(gòu): Whether the applicant is a charitable organisation for the purpose of section 88 of the Inland Revenue Ordinance - 否 是 (請(qǐng)?zhí)峁┒悇?wù)局發(fā)出的IR表格第302號(hào))No Yes (please provide Form 302 issued b

6、y the Inland Revenue Department)(b) 如屬個(gè)人，請(qǐng)?zhí)峁└綄贆C(jī)構(gòu)支持計(jì)劃的證明文件。 For individual applicants, please attach documentary evidence showing that support from their affiliated organisations have been obtained.(c) 請(qǐng)以不超過(guò)一頁(yè)文字提供申請(qǐng)人/機(jī)構(gòu)的簡(jiǎn)介Please provide a brief description of the applicant in no more than one page.附屬

7、機(jī)構(gòu)名稱及地址:Name and address of affiliated organisation:_IV.計(jì)劃撮要(請(qǐng)以不多於300字簡(jiǎn)介計(jì)劃的內(nèi)容)Project summary (please provide a concise summary of the project in no more than 300 words)撮要必須列明計(jì)劃目的、主要活動(dòng)及評(píng)估方法。The summary must set out objectives, key activities and evaluation measures.請(qǐng)?jiān)谶m當(dāng)方格加上“ü” 號(hào)，選擇可多於一個(gè)。Please

8、þ where appropriate. You can tick more than one box.V.計(jì)劃類別Project type (i) 預(yù)防教育和宣傳戒毒治療和康復(fù)Preventive Education & Publicity Treatment & Rehabilitation 研究Research (ii) 全港性Territory-wide 地區(qū)性(如屬地區(qū)性活動(dòng)，請(qǐng)?jiān)]明活動(dòng)舉行的地區(qū))District-wide (For district-wide events, please state the district(s) in which th

9、e events are to be held.) _ 香港以外的地方(請(qǐng)?jiān)]明)Outside Hong Kong (please specify)_VI.活動(dòng)計(jì)劃的對(duì)象(類別)Targets (type): _ 人數(shù) (number of participants to be reached): VII. (i) 預(yù)計(jì)開(kāi)始時(shí)間 Expected commencement date : _(日/月/年) (Day/Month/Year)(ii)計(jì)劃進(jìn)行年期 Project duration: _(iii)預(yù)計(jì)完成時(shí)間Expected completion date: _(日/月/年) (Day

10、/Month/Year)VIII. 財(cái)政預(yù)算 Budget (i)申請(qǐng)撥款總額Total grant sought: $_(ii)其他已獲得/正申請(qǐng)的贊助Any other sponsorship sought / being sought 沒(méi)有 No 有 Yes資助來(lái)源Source of fund 已獲得/正申請(qǐng)的資助Amount received*/applied for申請(qǐng)進(jìn)展Progress of application(a)(b)(c)(iii)財(cái)政預(yù)算分項(xiàng)數(shù)字 (請(qǐng)以不超過(guò)15個(gè)項(xiàng)目列出財(cái)政預(yù)算；如須另列細(xì)項(xiàng)，請(qǐng)另行以額外續(xù)頁(yè)提供有關(guān)資料)Budget breakdown (Ple

11、ase provide an overall budget with less than 15 items; Detailed accounts, if any, can be listed in separate sheet) (a)為計(jì)劃聘請(qǐng)員工詳情Details of Recruitment of Project Staff增聘員工的薪金應(yīng)以政府同類職位的起薪點(diǎn)為準(zhǔn)。如以較高薪金聘用員工，則須提出充分理由。(Appointees should normally be paid with the starting salary of similar posts in the Governm

12、ent. Strong justifications should be provided for the appointment of staff with higher salaries.)(1) 薪金及強(qiáng)積金Salary & Mandatory Provident Fund (MPF)職位Position全職/兼職*Full-time/Part-time*員工數(shù)目No. of staff(A)月薪Monthly salary(B)聘用月數(shù)Length of employment (in months)(C)申請(qǐng)款額Amount of grant applied for ($)(A

13、)x(B)x(C)(D) 小計(jì) Sub-total : 已根據(jù)撥款計(jì)劃指引第11段另紙?zhí)峤辉銎竼T工的詳細(xì)職務(wù)表。Detailed duty list(s) of the staff has/have been attached separately in accordance with paragraph 11 of the Funding Exercise Guide(1A)聘用代課老師申請(qǐng)Employment of relief teacher此部分只適用於研究計(jì)劃This part is only applicable to Research projects請(qǐng)另紙?zhí)峁┢赣么n老師的建議

14、書。建議書需詳列理由、所需人手?jǐn)?shù)目、職位、職務(wù)、聘用時(shí)間和薪酬，並需得到所屬院校的確認(rèn)(請(qǐng)參閱撥款計(jì)劃指引附錄A的要求及有關(guān)條款)。Please submit a proposal for employment of relief teachers with the use of separate sheets. The proposal should clearly describe the rationale for the needs, the number of relief teachers to be employed, the position of relief teacher

15、s, duties, duration of employment and salary. The proposal must be confirmed by the institution concerned (please refer to the requirements and conditions at Appendix A of the Guide).(D1)申請(qǐng)款額Amount of grant applied for $_(b)其他開(kāi)支項(xiàng)目詳情 (為計(jì)劃所聘請(qǐng)員工的薪金及強(qiáng)積金除外)Details of other expenditure items (Except salar

16、y and MPF of Project Staff)其他項(xiàng)目Other item(s)預(yù)計(jì)的支出Estimated expenditure($)預(yù)計(jì)的收入(如適用)Estimated revenue($)(if any)申請(qǐng)款額Amount of grant applied for ($)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(E) 小計(jì) 小計(jì) 小計(jì) Sub-total : Sub-total : Sub-total :(D)+(D1)* +(E)申請(qǐng)撥款總額Total grant sought : * 只限研究計(jì)劃 Applicab

17、le to Research projects onlyIX. #以往申請(qǐng)禁毒基金的詳情 Previous applications for Beat Drugs Fund 從未申請(qǐng) 曾經(jīng)申請(qǐng) _ 次No applications made beforeNumber of applications made before: 成功次數(shù)number of successful application(s):_失敗次數(shù)number of unsuccessful application(s):_X. #如在本年度提出超過(guò)一項(xiàng)申請(qǐng)，請(qǐng)排列各項(xiàng)計(jì)劃的優(yōu)先次序：For applicant who subm

18、its more than one application in this years exercise, please list out those applications/projects in order of priority:計(jì)劃名稱Project name申請(qǐng)金額Amount applied for ($)(i)_ _(ii)_ _(iii)_ _ 總計(jì) Total: # 如申請(qǐng)人/機(jī)構(gòu)屬母機(jī)構(gòu)轄下的分會(huì)/分區(qū)組織，第IX及X項(xiàng)必須由母機(jī)構(gòu)填寫。If an applicant is a branch or district office/agency under a mother

19、 organisation, items IX and X should be filled in by the mother organisation. 乙部 計(jì)劃詳情Part B Project Details(I)適用於非研究計(jì)劃For Non-Research Projects請(qǐng)另紙就項(xiàng)目(i)及(ii)提供不超過(guò)10頁(yè)資料:Please use separate sheets (of no more than 10 pages) for items (i) to (ii):(i)請(qǐng)就下列項(xiàng)目提供簡(jiǎn)要資料Please give concise information on the fo

20、llowing areas:a) 背景及活動(dòng)的可行性等其他資料background and other information such as the feasibility of the activitiesb) 目標(biāo)Objectives列出至少一項(xiàng)目標(biāo)。申請(qǐng)人/機(jī)構(gòu)應(yīng)能將列出的目標(biāo)轉(zhuǎn)化成特定的指標(biāo)，以監(jiān)察及評(píng)估計(jì)劃。List at least one objective. The applicant should be able to convert the stated objectives into specific indicators for monitoring and eval

21、uation.c) 監(jiān)察及評(píng)估計(jì)劃的指標(biāo)Indicators for monitoring and evaluation列出監(jiān)察計(jì)劃的指標(biāo)，申請(qǐng)人/機(jī)構(gòu)可提議多個(gè)指標(biāo)。請(qǐng)參閱附件所載的指標(biāo)例子。申請(qǐng)人必須使用以下格式：List the indicators for monitoring the projects. Applicant may propose more than one indicator. Please refer to Annex for examples of indicators.Applicant must use the following format:指標(biāo)Indi

22、cators對(duì)象Target population成果指標(biāo)一Output indicator 1成果指標(biāo)二Output indicator 2成果指標(biāo)三Output indicator 3成效指標(biāo)一Outcome indicator 1成效指標(biāo)二Outcome indicator 2成效指標(biāo)三Outcome indicator 3d) 監(jiān)察和評(píng)估計(jì)劃的機(jī)制Monitoring and evaluation mechanism 描述如何收集有關(guān)指標(biāo)的資料。申請(qǐng)人必須使用以下格式： Describe how information on the indicators would be collec

23、ted. Applicant must use the following format:指標(biāo)Indicators收集有關(guān)指標(biāo)的資料的方法Method of data collection成果指標(biāo)一Output indicator 1成果指標(biāo)二Output indicator 2成果指標(biāo)三Output indicator 3成效指標(biāo)一Outcome indicator 1成效指標(biāo)二Outcome indicator 2成效指標(biāo)三Outcome indicator 3e)除了指標(biāo)以外，請(qǐng)列明其他監(jiān)察及評(píng)估計(jì)劃的機(jī)制(可選擇提議)Please also state any monitoring a

24、nd evaluation mechanism other than indicators (optional)f)擬舉辦的活動(dòng)及活動(dòng)詳情。請(qǐng)列出每項(xiàng)活動(dòng)的相關(guān)目標(biāo)。 Proposed activities and programme. Please indicate the specific objectives associated with each activity.g)請(qǐng)列明計(jì)劃的時(shí)間表，並提出執(zhí)行計(jì)劃時(shí)可能會(huì)遇到的挑戰(zhàn)及導(dǎo)致未能達(dá)標(biāo)的因素，並提出相關(guān)的應(yīng)變計(jì)劃。 Please set out the project time-frame. Please also highlight

25、 any anticipated challenge that may cause underachievement of target and contingency plan.h)預(yù)期產(chǎn)品Expected deliverablesi)按年度詳列各項(xiàng)開(kāi)支項(xiàng)目的預(yù)算(包括薪金及強(qiáng)積金)。預(yù)算應(yīng)與甲部VIII部分相符。Budget, with detailed breakdown of the cost of expenditure items (including salary & MPF) for each project year. The budget should tally

26、with the budget proposed under Part A VIII.(ii) 請(qǐng)簡(jiǎn)要地提供以下資料 To provide concise information on the following areas:a) 計(jì)劃如何使有助推展禁毒工作 how the project would add value to anti-drug work b) 申請(qǐng)人/機(jī)構(gòu)如何就推行計(jì)劃作準(zhǔn)備 how the applicant would make preparations for implementing the projectc) 申請(qǐng)人/機(jī)構(gòu)推行有關(guān)禁毒預(yù)防教育、戒毒治療或青少年外展

27、工作的經(jīng)驗(yàn)relevant past experience in drug prevention programme, drug treatment programme or youth outreach programme d) 是否有其他有利申請(qǐng)人/機(jī)構(gòu)推行計(jì)劃的因素/設(shè)施 whether there are other favourable factors or facilities that favour the applicant in implementing the project(II) 適用於研究計(jì)劃For Research Projects請(qǐng)就研究計(jì)劃提供一份建議書。建議書

28、應(yīng)包括以下資料(如適用):Please submit a detailed research proposal, which should include the following information (if applicable):(i)請(qǐng)就下列項(xiàng)目提供資料Please provide information on the following areas:a)背景Backgroundb) 目標(biāo)Objectivesc) 研究方法Research methodologyd) 研究對(duì)象數(shù)目及性質(zhì)Number and nature of subjects involvede) 研究活動(dòng)連時(shí)間表

29、Research activities to be conducted and schedulef) 主要里程碑及中期成果Milestones and interim deliverablesg) 開(kāi)支預(yù)算(需要細(xì)分項(xiàng)目)Budget (with detailed breakdown)(ii)請(qǐng)簡(jiǎn)要地提供以下資料To provide concise information ona) 計(jì)劃如何使有助推展禁毒工作；及 how the project would add value to anti-drug work; andb) 申請(qǐng)人/機(jī)構(gòu)如何就推行計(jì)劃作準(zhǔn)備；及 how the applica

30、nt would make preparations for implementing the project; andc) 申請(qǐng)人/機(jī)構(gòu)推行有關(guān)禁毒預(yù)防教育、戒毒治療或青少年外展工作的經(jīng)驗(yàn) relevant past experience in drug prevention programme, drug treatment programme or youth outreach programme; andd) 是否有其他有利申請(qǐng)人/機(jī)構(gòu)推行計(jì)劃的因素/設(shè)施 whether there are other favourable factors or facilities that fav

31、our the applicant in implementing the project丙部 附加資料Part C Additional Information(i)基本建設(shè)工程(擬議計(jì)劃屬基本建設(shè)工程的申請(qǐng)人/機(jī)構(gòu)必須填寫此部分)Capital Works project (Applicants who propose capital works projects should fill in this part.)(a)請(qǐng)說(shuō)明計(jì)劃所涉及土地的使用權(quán)(例如是否已獲政府簽發(fā)政府土地牌照，批出契約和短期租約等)及其屆滿日期Please state the status (e.g. Govern

32、ment Land Licence, lease, short term tenancy, etc.) and expiry date of the land use for the proposed project.(b)請(qǐng)說(shuō)明是否已獲政府批準(zhǔn)使用土地作擬議用途(包括獲準(zhǔn)使用土地的契約修訂、年期和條款)。Please state whether approvals have been obtained from Government for using the site for the proposed project (including lease modification, tenur

33、e and terms for using the site). 否 No 是 (請(qǐng)?zhí)峁┳C明文件) Yes (Please provide supporting documents) (c)請(qǐng)說(shuō)明是否備有證明文件，例如承建商或建築商所提供的報(bào)價(jià)單、圖則、草圖和照片。Please state whether supporting documents such as quotations from contractors/architects, plans, sketch maps and photographs are available. 否 No 是 (請(qǐng)夾附有關(guān)文件、並註明文件類別) Ye

34、s (Please enclose and specify the types of documents available)(d)如計(jì)劃涉及興建新的建築物，請(qǐng)說(shuō)明建築圖則是否已獲有關(guān)當(dāng)局批準(zhǔn)。(如未獲有關(guān)當(dāng)局/政府部門批準(zhǔn)，申請(qǐng)通常不獲考慮。)For proposed project that involves construction of new buildings, please state whether the relevant building plans have been approved by the authorities concerned. (Application

35、will normally not be considered if approvals from relevant authorities / Government departments have not been obtained.) 否 No 是 (請(qǐng)夾附證明文件) Yes (Please enclose supporting documents) 不適用 Not applicable(e)請(qǐng)說(shuō)明計(jì)劃會(huì)否涉及經(jīng)常費(fèi)用，例如員工薪津和維修開(kāi)支等。Please state whether the proposed project will incur any recurrent cost,

36、 e.g. staff and maintenance costs 否 No 是 (請(qǐng)說(shuō)明以往或日後支付經(jīng)常費(fèi)用的安排) Yes (Please state the means that have been used or are in plan to meet the recurrent costs.)(ii) 非基本建設(shè)工程 (擬議計(jì)劃屬非基本建設(shè)工程的申請(qǐng)人/機(jī)構(gòu)必須填寫此部分) Non Capital-works Project (Applicants who propose non-capital works projects should fill in this part.)請(qǐng)說(shuō)

37、明計(jì)劃是否非經(jīng)常性推行，或已有構(gòu)思在禁毒基金撥款期過(guò)後長(zhǎng)遠(yuǎn)推行該計(jì)劃。請(qǐng)同時(shí)說(shuō)明在資助期屆滿而未能取得其他撥款時(shí)，如何處理尚未完成的工作或尚待提供服務(wù)的個(gè)案。Please indicate whether the project is one-off in nature, or whether there is any long-term plan beyond the funding period of the Beat Drugs Fund. Please also indicate how any outstanding tasks/remaining clients of the pr

38、oject will be handled/served if there is no alternative source of funding on expiry of the grants from the Beat Drugs Fund._(iii)申請(qǐng)撥款購(gòu)買固定資產(chǎn)的計(jì)劃Project requesting funding for capital items如申請(qǐng)撥款購(gòu)買固定資產(chǎn)(例如辦公室器材或車輛等)，請(qǐng)簡(jiǎn)述絕對(duì)需要該項(xiàng)資產(chǎn)以推行計(jì)劃的理?yè)?jù)。申請(qǐng)者亦須說(shuō)明其他方案(例如租用固定資產(chǎn)或使用申請(qǐng)人/或機(jī)構(gòu)的固定資產(chǎn))不可行或不符合經(jīng)濟(jì)效益的理由。For applicant who

39、proposes to procure capital item (for example, office equipment or vehicle), please describe briefly how the capital item is absolutely essential for implementation of the project. Applicant should also explain how other options (such as hire/renting of the capital item or use of applicants capital

40、item) are not practical nor cost effective._(iv) 申請(qǐng)撥款超過(guò)300萬(wàn)元及/或?yàn)槠趦赡暌陨系挠?jì)劃 Proposed project exceeds $3 million and/or last more than 2 years.如申請(qǐng)撥款超過(guò)300萬(wàn)元及/或計(jì)劃為期兩年以上，請(qǐng)列舉擬議計(jì)劃與現(xiàn)有服務(wù)或活動(dòng)不同之處，並說(shuō)明擬議計(jì)劃如何配合或補(bǔ)足現(xiàn)有服務(wù)或活動(dòng)。For applicant whose proposed project exceeds $3 million and/or lasts for more than 2 years, ple

41、ase state how the proposed project differs from or supplements current services._#謹(jǐn)此證明，據(jù)本人/我們*所知，申請(qǐng)表內(nèi)所填報(bào)的資料均正確無(wú)訛。本人/我們*同意，如擬議計(jì)劃獲禁毒基金會(huì)批準(zhǔn)，表格內(nèi)所提供的資料對(duì)申請(qǐng)人/機(jī)構(gòu)具有約束力。本人/我們*又保證，如日後本人/我們*向其他方面申請(qǐng)資助同一計(jì)劃，定必通知禁毒基金會(huì)秘書。I/We* certify that the information given in this Application Form is correct according to the bes

42、t of my/our* knowledge. I/We agree that the information provided in this application would be binding on the applicant if the proposed project is approved by the Beat Drugs Fund Association. I/We* also undertake to inform the Secretary, Beat Drugs Fund Association if, subsequent to this application,

43、 I/We* apply for funds from other sources for the same project.簽署Signature:職銜Post title:姓名Name:日期Date:機(jī)構(gòu)蓋章Official Chop#如屬機(jī)構(gòu)，須由機(jī)構(gòu)高級(jí)人員填寫。If the applicant is an organisation, this item should be completed by a senior officer of the organisation.*刪去不適用者 delete where appropriate申請(qǐng)書覆函ACKNOWLEDGEMENT OF APPLICATION我們已收到你的申請(qǐng)書，現(xiàn)正詳加審閱。禁毒基金會(huì)秘書處蓋章Official Chop of Secretariat ofBeat Drugs Fund AssociationYour application has been received and is now being stud